Quote

H. G. Ellis Agency, Inc.

For All Your Insurance Needs

Camden (315) 245-1270, Constantia (315) 623-7765, Cazenovia (315) 655-9066

Please bear with us while we get the electronic submission form set up. Please call or e-mail the closest office for quote or appointment.
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Get A Quote- Watercraft and Jet Ski

Please fill out the following form to the best of you knowledge and we will quote your policy as soon as possible. If we need additional information we will contact you.
oneida lake chamber

Oneida Lake/ Ft. Brewerton Chamber of Commerce

camden chamber

Camden Chamber of Commerce
caz chamber1

Cazenovia Chamber of Commerce

The following questions are used to help determine the proper company and rate to assign to your risk. Answering the questions will only help your rate and will not hurt it. You do not have to answer anything you do not want to. We do not give out or sell any information provided. We will run motor vehicle reports and accident reports to verify all information provided.

Name

Mailing Address

Garaging Address

Phone #

Preferred method of contact

US Mail

Email

Phone

Email

DRIVERS

Please list anyone who may drive the vehicle

Name

DOB

License Number

# Years Licensed

License State

Do you have a motorcycle license

Social Security #

Years of boating experience

Name

DOB

License Number

# Years Licensed

License State

Do you have a boaters license

Social Security #

Years of boating experience

Additional Drivers

Name

DOB

License #

License state

Tickets and/or Accidents

Please list the driver, date and details of any accident or ticket received in the last 5 years

Driver

Driver

Discount Info.

Do you currently have watercraft insurance

If yes, what company

Annual premium

Is the watercraft garaged

Are you a member of a club

Did you take the Defensive driving or other safety course

Are you a homeowner

To receive a discount, can you provide proof of ownership

Vehicle Info. (1)

Vehicle Type

Year

Make

Length

Description

Model

Unit Value

Hull ID Number

Hull material

Hull type

Purchase Price and date

Number of motors

Trolling motor

Exposed engine or overtransum exhust

Modified or enhanced performance

Safety Equipment

Fire extinguisher

Motor Year

Make

Depth Finder

Serial Number

Other

Max Speed

Fuel

HP

Value

Would you like physical damage

Vehicle Info. (2)

Vehicle Type

Year

Make

Length